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Epiduroscopy - is endoscopic diagnosis and therapy of pain in the spinal cord.

Under Epiduroscopy mean percutaneous minimally invasive endoscopic examination of the epidural space, allowing a three-dimensional, colored images of anatomical structures in the spinal cord, as Dura mater spinalis, Ligamentum flavum, Ligamentum longitudinale posterior, blood vessels, neural structures and fatty tissue. And pathological structures and changes, such as spikes, sequestration, inflammation, fibrosis and stenosing processes can be identified with the endoscopic technique.

Epiduroscopy procedure - percutaneous minimally invasive endoscopic examination of the epidural space.


Indications for Epiduroscopy

Diagnosis of pain in the spinal cord is the main indication for epiduroscopy. Differentiation of pathological relationships, such as epidural fibrosis after invasive procedures and radiculopathy, as well as holding the so-called «Memory Pain» - procedures expand the spectrum of diagnostic evidence. To the therapeutic indications for epiduroscopy include procedures such as targeted local drug therapy, a biopsy, removal of scars, placement of catheters and implantation of stimulating electrodes under the direct supervision of a case of difficult passage into the epidural space or, if the radiological method of placement is not possible, or whether there is a risk to the patient. Epiduroscopy as an auxiliary method for minimally invasive surgery is another example of therapeutic indications.


Necessary conditions for Epiduroscopy

The basic condition for achieving efficiency for Epiduroscopy and patient safety are the experience of conducting surveys as well as profound theoretical knowledge and certain skill and mastery of a specialist doctor at the pain of invasive treatment. In addition to accurate diagnosis of pain and professional technical management of the success of interventional pain therapy with epiduroscopy support depends on the choice of a competent patient. Prerequisite for invasive Epiduroscopy survey is a thorough clinical and functional examination, as well as giving an image diagnosis. Regardless of the structure of the clinic epiduroscopy should be possible only in patients who are ready to cooperate, as well as under constant supervision and control of vital functions in the respective operating room.


Access method to the epidural space

In accordance with the sacral access to the epidural space of the patient is placed on the operating table in pronation. After thorough disinfection of the vast area of the skin and a sterile cover over the sacral foramen (Hiatus) performed local anesthesia. After the start of local anesthesia with needle cannula from the set for sacral puncture holes made at an angle of 45 ° and at a distance of 4 cm from natal cleft sulcus (Rima ani). After the guide cannula perforated Ligamentum sacrococcygeum, by adjusting the axial position of the cannula into the spinal canal.

After negative aspiration test on two levels you can enter the guide rod at a shallow depth in the sacral foramen (Hiatus sacralis). To identify the guide rod in the sacral foramen (Hiatus sacralis) helps control lateral fluoroscopy. After a small puncture incisions, can be administered dilator size 9.5 Fr. with extension to the side attachment for the handset via the rod percutaneously into the spinal canal. Plastic gateway from a set of input placed in the sacral foramen, provides a reliable relatively atraumatic sacral input, as well as promotion epiduroscopy and a very important protection of the shift.


Perform an operation of percutaneous Epiduroscopy

To conduct of epiduroscopy need a continuous and controlled epidural lavage physiological saline through the working channel of epiduroscope. Epiduroscopy depending on the anatomical structure of the spinal canal and a professional survey methodology can be conducted through the sacral foramen (Hiatus sacralis) in the direction from the sacral to the cervical. For such interventions epiduroscopy support, such as biopsy, dissection of adhesions, resection of scar tissue, stopping the blood and removal of foreign bodies through the working channel of epiduroscope available to the surgeon are flexible surgical instruments, the laser fiber and catheter. There is a possibility of endoscopic resection of scar tissue, depending on the result of post-mortem analysis in certain limits.

Due to anatomical data the spinal canal tip of epiduroscope amenable to navigate only in narrow, given the anatomical features, the boundaries. With the help of careful external rotation of epiduroscope or changes in direction of epiduroscope tip that can be operated in areas up to 120 ° and down to 170 °, you can improve the position of the tip of the epidural part of epiduroscope. To achieve the surveyed area, despite the commissural zones, using Grasping forceps, or using laser welding and fibrotic areas of tissue can be mobilized or removed. Epiduroscope height position in the spinal canal can be easily identified by X-ray image converter. To date, there Epiduroscopy marked at a distance of 5 cm, allowing doctors to easily determine the height position. To achieve the goal in the epidural space epiduroscopy in any case should not proceed blindly or with the use of force. Constant and optimum endoscopic survey provides protection against accidental complications.

At the end of epiduroscopycal interventions being tested in dry blood. In conclusion, epiduroscope under constant optical control carefully removed from the epidural space. To ensure the reliability of epiduroscopy need to fix the protocol. It is recommended to save the results of endoscopic examination in the video and / or video printer or on a CD or DVD. Epiduroscopy makes an important contribution to ensure the reliability of patients and quality control. Without significant additional burden for the patient epiduroscopy expands the diagnostic and therapeutic possibilities and opens up, especially in the treatment of chronic pain syndromes in spinal cord, new ways for their therapy, and long before their chronic forms.


Used tools for percutaneous Epiduroscopy

  • Flexible epiduroscope - Designed for sacral access to the epidural space (Spatium epidurale) epiduroscope with outer diameter 2.8 mm impression, above all, his great perspective and flexibility of a managed distal end (120 ° upwards, 170 ° down), and the diameter working channel 1.2 mm.
  • Kelectome - To obtain samples of tissue from the epidural space can introduce an appropriate microsurgical instruments through the working channel of epiduroscope.
  • Additional equipment - For optimum performance of endoscopic images to epiduroscope connected digital endoscopic camera IMAGE 1 ™, as well as the color monitor. Camcorder IMAGE 1 ™ ensures the resolution and sensitivity needed to obtain the highest quality digital image.
  • For digital preservation and archiving of fixed images, video sequences, audio and external data on CD-ROM, DVD or in a database can be connected to the system of endoscopic equipment KARL STORZ AIDA DVD ™ or AIDA DVD. These systems are compact, digital video recorders and alternative video printer.


Indications for percutaneous Epiduroscopy

  • Image pathological conditions
  • Targeted use of drugs
  • Placement systems catheterization
  • SCS-implantation of electrodes (neuromodulation)
  • Support for minimally invasive surgery

Advantages of the catheter and implanted SCS-electrode supporting EDS:

  • Safe epidural access
  • Epidural diagnosis
  • Accurate placement of catheters or electrodes
  • Bypassing obstacles postmortem
  • Speeding up the process of implantation
  • Reducing the load on the x-ray
  • Improving the possibility of documenting


Contraindications for percutaneous Epiduroscopy

Contraindications for percutaneous epiduroscopy match contraindications for local anesthetics in the spinal cord. Important additional contraindications are:

  • Bleeding diathesis
  • Anticoagulant treatment (exception: mild heparinization in controlling blood clotting, the appointment of acetylsalicylic acid, epiduroscopy after 4 days)
  • Infection in the puncture site
  • Neurological disorders
  • Patients with high cardiovascular risk
  • Refusal of a patient from epiduroscopy


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